Inpatient suicide: reliance and reliability of “no suicide contracts”

Suicide is the seventh leading cause of death in the US. An estimate of 37,000 people dies every year by suicide in the US, of which 6 percent are attributed to inpatient suicide. Despite taking certain measures to prevent inpatient suicide like assessing the risk factors and treating the underlying psychiatric condition appropriately, continuous monitoring and making patients sign no-suicide contracts, the rate has not decreased significantly. Sixty-five percent of people who commit inpatient suicide sign the no-suicide contract beforehand. This reflects that these contracts are less effective in reducing the inpatient suicide rate. Moreover, such contracts can give an impression to the patients regarding mistrustful attitudes from the doctor’s or therapist’s side. These contracts can also provide a false sense of security to psychiatrists and decrease their clinical vigilance. Also, these contracts do not protect the physicians from malpractice judgments if lawsuits occur. Also, if we think a signed contract can give a positive incentive for the patient to avoid suicide, this could have been achieved with just good counseling and therapy to reinforce the strength of self-controlling themselves and decrease suicidal ideation. Rather, it is essential to focus on proper suicide assessment, accurate and safe monitoring of high-risk patients and removing environmental dangers. Most importantly psychiatrists should make sure to develop a good therapeutic alliance with the patients to prevent and decrease inpatient suicidal rates instead of entirely relying on no suicide contracts. In this paper, we will review risk factors for inpatient suicide, the validity of the risk assessment, strategies to prevent inpatient suicide, and we will later discuss the reliability of no-suicide contracts to prevent suicide.